IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF KENTUCKY
UNITED STATES OF AMERICA, Plaintiff
COMMONWEALTH OF KENTUCKY, et al., Defendants
TABLE OF CONTENTS
I. INTRODUCTION 3
II. DEFINITIONS 4
III. BACKGROUND 6
IV. SUBSTANTIVE PROVISIONS 8
A. Protection From Abuse, Mistreatment, and Injury 8
B. Treatment Services 14
C. Education & Vocational Training & Structured
(1) General Population 17
(2) Juveniles with Disabilities 17
(3) Structured Activities 19
D. Aftercare Treatment Services 20
E. Time-Out and Isolation 21
F. Staffing, Operational, and Security Procedures 24
G. Medical Care 27
H. Mental Health Care 30
I. Classification 35
J. Fire Safety 36
K. Bedspace and Overcrowding 37
L. Maintenance and Sanitation 37
V. TREATMENT CENTER CONSTRUCTION AND/OR RENOVATION 37
VI. CONSTRUCTION, IMPLEMENTATION, AND TIMING OF COMPLIANCE 38
VII. APPENDICES 44
1. The United States enters into this agreement
pursuant to its authority under the Civil Rights of
Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997 et
seq., and the provisions of Pub. L. No. 103-322, 108 Stat. 2071
(codified at 42 U.S.C. § 14141) concerning the administration of
2. The overall purpose of the parties in entering into
this Consent Decree is to achieve the outcomes delineated below,
and the Decree shall be read and interpreted in light of these
a. Juveniles confined in Kentucky treatment
centers have a right to treatment reasonably calculated to
improve their condition and promote their personal growth and
development. Such treatment involves a continuum of services
provided in the community and institutional settings;
b. Every juvenile committed to the custody of the
Defendants has a right to receive individualized and appropriate
care and treatment that is safe and humane and is provided in the
least restrictive setting consistent with the juvenile's needs; c. Defendants shall utilize their community based
juvenile services to the maximum extent feasible.
3. This Court has jurisdiction over this action
pursuant to 28 U.S.C. § 1345.
4. Venue in the Western District of Kentucky is
appropriate pursuant to 28 U.S.C. § 1391(b).
5. The United States has met all pre-filing
requirements stated in the Civil Rights of Institutionalized
Persons Act, 42 U.S.C. § 1997 et seq.
6. "Plaintiff" shall refer to the United States of
7. "Defendants" shall refer to the Commonwealth of
Kentucky; Governor Brereton C. Jones, in his official capacity;
Masten Childers II, Secretary of the Kentucky Cabinet for Human
Resources ("CHR"), in his official capacity; Peggy Wallace, the
Commissioner of the Department for Social Services, in her
official capacity; Betty Shipp, the Director of Youth Services,
in her official capacity; Elizabeth Wachtel, the Commissioner for
Mental Health and Mental Retardation, in her official capacity;
and the agents and successors in office of the above listed
individuals and offices.
8. The terms "juvenile" or "juveniles" shall refer to
one or more individuals sentenced to, incarcerated in, detained
at, or otherwise confined at any residential treatment facility
operated or funded by the Commonwealth of Kentucky, including the
Central Kentucky Treatment Center ("CKTC").
9. The term "juvenile treatment facility", "juvenile
treatment center" or "residential treatment center" shall refer
to any residential facility of more than eight beds presently or
in the future during the operation of this Consent Decree, owned,
operated, or funded by the Commonwealth of Kentucky that
incarcerates, detains, or otherwise confines juveniles for the
purpose of providing treatment services, including education and
counseling services. At a minimum, this term shall include the
following treatment centers: Bluegrass Treatment Center, Cardinal
Treatment Center, Central Kentucky Treatment Center, Green River
Boys' Camp, Johnson-Breckinridge Treatment Center, Lake
Cumberland Boys' Camp, Lincoln Village Treatment Center, Mayfield
Boys' Treatment Center, Morehead Treatment Center, Northern
Kentucky Treatment Center, Owensboro Treatment Center, KCH Rice-Audubon Treatment Center, and Woodsbend Boys' Camp. This
definition does not include short term pre-adjudication detention
10. The term "special needs juvenile" shall refer to
those juveniles who are suicidal, mentally ill, mentally
retarded, emotionally disturbed, under the influence of alcohol
or other substances, or a danger to themselves or others.
11. The term "isolation" shall mean any placement of a
juvenile in a room without normal staff and peer interaction for
a period of one hour or more.
12. The term "time-out" is defined as any placement of
a juvenile in a room without normal staff and peer interaction
for less than one hour.
13. The term "competency-based" training shall mean
that staff shall demonstrate to his or her supervisor and/or
trainer his or her ability or competency to perform a specified
skill through an active hands-on demonstration of such skill.
14. The term Qualified Mental Health Professional
("QMHP") shall be defined by Ky. Rev. Stat. Ann. § 202A.011(12)
(Supp. 1994) attached to this Consent Decree as Appendix A. The
above definition of QMHP shall govern this term for the duration
of this Consent Decree regardless of any statutory amendments to
Ky. Rev. Stat. Ann. § 202A.011(12) by the Commonwealth.
15. The Defendant Commonwealth of Kentucky owns and
funds the operation of the Commonwealth's juvenile residential
16. In their official capacity, the Defendants
Secretary of the Cabinet for Human Resources, the Commissioner of
the Department for Social Services, and the Director of Youth
Services are responsible for the day-to-day operation of various
Kentucky residential treatment facilities. Defendant Elizabeth
Wachtel, the Commissioner for Mental Health and Mental
Retardation, is responsible for providing mental health services
to juveniles in the various Kentucky residential treatment
17. On February 9, 1995, and May 1, 1995, the United
States notified Governor Jones and other Kentucky officials of
the United States' intent to investigate various Kentucky
juvenile treatment centers for the Commonwealth of Kentucky
pursuant to the Civil Rights of Institutionalized Persons Act
("CRIPA"), 42 U.S.C. § 1997 et seq., and the provisions of Pub.
L. No. 103-322, 108 Stat. 2071 (codified at 42 U.S.C. § 14141)
concerning the administration of juvenile justice. The United
States toured the Owensboro Treatment Center and Green River Boys
Camp with expert consultants on April 26-28, 1995. The United
States toured the Johnson-Breckinridge Treatment Center, Rice-Audubon Treatment Center and Central Kentucky Treatment Center
with expert consultants on May 9-13, 1995. On July 28, 1995, the
United States issued a findings letter based on the tour of its
experts and found that conditions in Kentucky juvenile treatment
centers violated the constitutional and federal statutory rights
of the juveniles.
18. On July 28, 1995, Kentucky responded to the United
States' findings in a letter from Secretary Masten Childers to
Assistant Attorney General Deval Patrick. In that letter,
Kentucky expressed its intent to promptly address the United
States' findings. From that date to the present, Kentucky has
worked cooperatively with the United States to remedy the
conditions detailed in the findings letter. At the date of the
signing of this Consent Decree, Kentucky has begun implementing a
number of this Consent Decree's requirements.
19. The parties to this Decree recognize the
constitutional and federal statutory rights of juveniles confined
in Kentucky's juvenile treatment centers. After discussions and
in order to avoid litigation concerning the constitutionality of
the care and confinement of juveniles and of the actions of
officials and employees of Kentucky at its juvenile treatment
centers, the parties agree to the provisions set forth in this
IV. SUBSTANTIVE PROVISIONS
A. Protection From Abuse, Mistreatment, and Injury
20. Defendants shall adequately protect the juveniles
within Kentucky residential treatment centers from harm, abuse,
neglect, exploitation and/or other mistreatment, including
physical, verbal, and/or psychological mistreatment. In order to
adequately protect the juveniles, Defendants shall implement the
provisions contained in ¶¶ 20-34.
21. Defendants shall institute an adequate uniform
special incident reporting system that ensures that all special
incidents are promptly and adequately identified, reported,
investigated and tracked. Defendants shall ensure that the
definition of what constitutes a special incident is clear,
objective, unambiguous, and easily understood by juveniles and
staff of the juvenile treatment centers. The definition of a
special incident shall include all alleged incidents of abuse,
neglect, mistreatment, exploitation and/or injury. The special
incident reporting system shall consist of the following
a. Defendants shall create a factfinding
investigative unit outside the Department of Social Services or
any department or agency given supervising authority over
juvenile treatment facilities and/or staff. The investigative
unit shall report to the Juvenile Services Review Board created
under ¶ 21(b) and shall be responsible for factfinding only. The
investigative unit shall have sufficient staff to adequately
perform its duties;
b. Defendants shall create a Juvenile Services
Review Board responsible for evaluating investigative reports
submitted to them by the factfinding external investigative unit,
determining whether the facts substantiate a finding of abuse,
neglect, mistreatment and/or exploitation, and suggesting
appropriate disciplinary action;
c. Defendants shall create a quality assurance
management unit composed of persons outside the Department of
Social Services to check the quality, efficacy, and promptness of
special incident investigations.
22. The factfinding investigative unit shall have the
following specific responsibilities:
a. Investigate in a timely manner all allegations
of special incidents and prepare a written report of the
investigation and its findings, specifying the occurrences
surrounding the special incident and whether or not the
perpetrator has been identified;
b. Prepare and provide a report in a timely
manner and in writing to the Inspector General of Kentucky, the
Juvenile Services Review Board, and place the Department of
Social Services on notice of all special incident investigations;
c. Track the time, location, and staff present
for all special incidents. The investigator will analyze this
information for trends and when trends emerge, report such
information to the Juvenile Services Review Board and the
Director of Youth Services;
d. Assist in training all staff on reporting
allegations of special incidents and on preserving evidence.
23. The members of the factfinding investigative unit
shall receive adequate training in conducting investigations in
institutions serving juveniles, including classroom and field
24. Any member of an investigative unit shall have the
authority to immediately investigate any suspected special
incidents whether or not a formal complaint has been filed.
25. The Juvenile Services Review Board shall be
composed of sufficient numbers of persons to ensure the
attendance of at least five members at all meetings, the majority
of whom shall not be employed by Kentucky. One of the Board
members shall be a member of the Department of Public Advocacy,
Protection and Advocacy Division.
26. Defendants shall develop and implement, or ensure
that the quality assurance management unit develops and
implements, a reliable protocol for checking the quality of all
special incident investigations. The quality assurance protocol
shall ensure that a reliable sample of special incident
investigations are reviewed, including investigations found by
the Juvenile Services Review Board to be "unsubstantiated" or
"unfounded". The quality assurance management unit shall make
periodic and unannounced external monitoring visits of juvenile
treatment facilities and programs.
27. The Defendants and any state agency or Department
with current and/or future oversight or involvement with juvenile
treatment centers and all juvenile treatment centers shall
develop and implement adequate policies and procedures that
detail how to adequately recognize special incidents, promptly
report such incidents to appropriate protective and investigative
service agencies, promptly take effective action to protect the
juvenile, implement appropriate disciplinary action, and
adequately track special incidents in an effective, comprehensive
manner. Such policies and procedures shall include the
a. Policies and procedures shall detail the
specific requirements of each staff and non-staff member in
reporting, investigating and tracking special incidents and shall
offer step by step instructions that delineate clearly individual
staff member responsibility for reporting potential abuse;
b. Reporting of special incidents shall be
mandatory on all facility staff and non-staff members such as
medical contractors and/or teachers and shall occur at the time
the special incident is witnessed or discovered;
c. Defendants shall identify high-risk situations
of abuse and mistreatment and train staff and non-staff members
in how to recognize and handle such high risk situations of abuse
d. All staff and juveniles shall have easy and
quick access to any investigative agency;
e. Staff shall be adequately trained concerning
their responsibilities for preventing, recognizing, reporting and
responding to abuse and shall sign a statement to that effect; f. Juveniles shall be adequately informed as to
the procedures for reporting alleged special incidents and shall
have access to an investigative agency outside the facility for
the purpose of reporting alleged special incidents without
facility staff intervention or involvement;
g. Staff at the treatment center shall not be
involved in reporting of special incidents by juveniles.
Juveniles shall have access to someone outside the facility in a
timely fashion without having to contact staff or fill in forms
ultimately mailed by staff;
h. Defendants shall institute a priority system
that adequately identifies special incidents from other incidents
to facilitate the prompt investigation of all special incidents;
i. Defendants shall institute adequate policies
and procedures for disciplining staff for abuse and mistreatment
of juveniles. Such policies and procedures shall include clear
and adequate punishments for demonstrated incidents of abuse,
neglect, exploitation and/or mistreatment.
28. Defendants shall ensure that reporters of
suspected and known special incidents are protected from
retaliation and shall inform staff and juveniles of their right
to be free from retaliation.
29. Defendants shall take prompt administrative action
in response to allegations of abuse and mistreatment and shall
vigorously pursue actions before the Kentucky Personnel Board.
30. To the maximum extent possible as permitted by the
Commonwealth's regulations governing personnel practices,
Defendants shall institute personnel practices that protect
juveniles in the treatment centers from continued contact with
alleged perpetrators of abuse and mistreatment, especially during
investigation and review of the alleged special incidents.
31. If the Kentucky Personnel Board rejects
Defendants' disciplinary action for dismissal arising from abuse
allegations against one of its employees, Defendants shall take
all possible action to avoid placing such staff member back into
any position involving direct contact with juveniles pending any
review and/or appeal.
32. Defendants shall refer all alleged or suspected
crimes against juveniles by staff to outside authorities for
investigation. In doing so, Defendants shall not transfer or
diminish its responsibility to promptly investigate and
adequately discipline staff for incidents of abuse and
mistreatment. Responsibility for prompt and adequate
investigation and resolution of special incidents lies with the
Defendants and may not be shifted to outside law enforcement
33. In no event shall Defendants use mace or other
chemical agents on the juveniles.
34. Defendants shall abide by Administrative Order HR
95-122 signed by Masten Childers II, the Secretary for Human
Resources on October 24, 1995, and incorporated into this Consent
Decree as Appendix B, to the extent such order applies to the
Commonwealth's juvenile residential treatment centers.
B. Treatment Services
35. All juveniles shall have adequate Individual
Treatment Plans ("ITPs"). In order to provide the juveniles with
adequate ITPs, Defendants shall implement the provisions
contained in ¶¶ 35-43.
36. No later than 21 days after admission, a
multidisciplinary team of direct care staff and qualified
professionals, including the facility based psychologist, shall
meet with the juvenile to assess a juvenile's treatment needs. A
member of the facility's medical staff shall attend such
treatment meeting with appropriate medical information and
37. No later than 30 days after admission, the
multidisciplinary treatment team shall develop and implement an
initial Individual Treatment Plan ("ITP") for each juvenile
housed at the treatment facilities. Qualified and adequately
trained professional staff, including the facility based
psychologist, shall coordinate and oversee the development and
implementation of the ITP plans. A final, complete, and full ITP
shall be developed and implemented within 45 days of admission.
38. The ITP shall include meaningful and specific
short-term and long-term treatment goals and appropriate periodic
reevaluation and follow-up. The ITP shall adequately delineate
staff responsibilities for the programs. The ITP shall include
any psychiatric/psychological evaluations with recommendations
and actions noted and a plan for follow-up by the
multidisciplinary treatment team based on the evaluations. If an
ITP is ineffective, the multidisciplinary treatment team shall
timely modify the plan, with oversight from the facility based
psychologist. ITPs shall be kept in the juvenile's record.
39. Defendants shall provide sufficient services to
adequately implement, maintain, and modify each juvenile's ITP.
40. Defendants shall hire sufficient and qualified
staff and counselors to implement all ITPs and shall provide
adequate access to sufficient outside consultant services
necessary to meet the goals identified in the ITPs.
41. Defendants shall indicate in each juvenile's ITP
the specific criteria and goals that the juvenile must meet or
satisfy in order to gain release from the treatment facility.
Defendants shall not arbitrarily withhold release from a juvenile
that has satisfied his or her release goals and criteria. The
release goals and criteria shall contain clear timelines for
release. Defendants shall inform juveniles clearly of the goals
and timeliness relevant to his or her release from the facility.
42. Every juvenile's ITP shall address the provision
of aftercare services and shall, if such services are required,
identify factors necessary to the provision of meaningful
aftercare services, such as factors that contribute to the risk
that the juvenile will become a repeat offender.
43. Defendants shall establish specific formats and
guidelines for therapeutic activity required under juvenile
individual treatment plans, including the following:
a. Individual and group counseling shall be
conducted only by staff members who have been adequately trained
and credentialed/certified under the various training programs
offered for such activity through the Department for Social
Services for college and/or graduate study credit at the
universities within Kentucky;
b. Group activity shall be of manageable size not
to exceed eight residents;
c. At least two staff members shall be present to
conduct group activities;
d. Defendants shall adequately and regularly
document all individual and group counseling.
C. Education & Vocational Training & Structured Activities
44. All juveniles, including juveniles with
disabilities, shall have adequate educational and vocational
services that are individualized to meet each juvenile's
rehabilitative needs. In order to provide the juveniles with
adequate educational and vocational services and adequate
structured activities, Defendants shall implement the provisions
contained in ¶¶ 44-57.
(1) General Population
45. Defendants shall continue to provide all juveniles
housed at the treatment facilities with adequate educational and
vocational services. Defendants shall ensure that an adequate
number of qualified and experienced teachers are available to
provide such services. Defendants shall continue to provide
adequate instructional material and space for educational
46. Within 30 days of admission, Defendants shall
assess a juvenile's education needs and develop and implement an
individual education plan with meaningful and specific
educational and vocational goals to address identified needs.
47. Qualified professionals shall review and revise a
juvenile's individual education plan with appropriate frequency.
(2) Juveniles with Disabilities
48. Defendants shall abide by all mandatory
requirements and timelines set forth under the Individuals with
Disabilities Education Act, 20 U.S.C. §§ 1401 et seq.
49. Defendants shall screen a juvenile for physical
and learning disabilities. The screening shall include questions
about whether the juvenile has been previously identified by the
public school system as having an educational disability,
previous educational history, and a sufficient medical review to
determine whether certain educational disabilities are present,
such as hearing impairments, including deafness, speech or
language impairments, visual impairments, including blindness,
mental retardation, or serious emotional disturbances adversely
affecting educational performance.
50. If a juvenile has been previously identified as
having an educational disability, Defendants shall take all
lawful steps to immediately obtain a copy of the juvenile's
individualized education plan ("IEP") required under the
Individuals with Disabilities Education Act, 20 U.S.C. §§ 1401 et
seq. Defendants shall assess the adequacy of the juvenile's IEP
and either implement it as written if it is an adequate plan or,
if the IEP is inadequate, rewrite the plan to make it adequate,
and then implement the revised IEP. If Defendants are unable to
obtain a juvenile's original IEP in a timely manner, Defendants
shall create an IEP for such juvenile.
51. If the juvenile has not been previously identified
as having an educational disability, but indications of such a
disability exist, an adequate evaluation must be performed within
the time limits prescribed by federal law. Kentucky shall use
only professionally accepted tests to complete the evaluation. A
copy of this educational evaluation shall be kept in the
juvenile's record at the facility.
52. If a juvenile referred for an evaluation pursuant
to the above paragraph is discharged from the system before the
evaluation is complete, Defendants shall forward all information
regarding screenings and evaluations completed to date to the
juvenile's receiving school district, noting what evaluations are
yet to be performed.
53. Qualified professionals shall develop and
implement an IEP, including appropriate related services, based
upon an adequate evaluation and reasonably calculated to provide
educational benefits for every juvenile identified as having a
disability. When appropriate, the IEP shall include a vocational
54. The IEP shall include meaningful and specific
short-term and long-term treatment goals and appropriate periodic
reevaluation and follow-up. When an IEP is ineffective,
Defendants shall ensure that qualified professionals timely
modify the plan. IEPs shall be kept in the juvenile's record.
55. Defendants shall integrate the IEP with the ITP
for the juvenile.
(3) Structured Activities
56. Defendants shall provide a structured recreation
program, including outdoor and indoor recreation, with set and
specific guidelines for such activity. Defendants shall provide
the juveniles with an adequate exercise regimen of activity each
day, seven days per week.
57. Defendants shall hire sufficient staff and
maintain adequate exercise equipment and space to meet the above
requirements for recreation.
D. Aftercare Treatment Services
58. All juveniles shall have adequate aftercare
treatment services. In order to provide the juveniles with
adequate aftercare treatment services, Defendants shall implement
the provisions contained in ¶¶ 58-66.
59. Defendants shall develop and implement written
policies and procedures for the provision of aftercare treatment
services to juveniles. Defendants shall implement and monitor
adherence to such policies and procedures.
60. Defendants shall develop and implement an
aftercare services screening tool to identify specific problem
areas to address during aftercare treatment, including the risk
of becoming a repeat offender. This screening tool shall be part
of the multidisciplinary ITP process and shall be administered by
trained staff members. The juvenile's court records,
psychological and social evaluations, family history, and
educational records must be considered in this screening process.
61. Defendants shall provide meaningful aftercare
treatment services to all juveniles who exhibit a risk of
becoming repeat offenders as identified through screening or
through the course of the treatment program.
62. Defendants shall immediately assign an aftercare
worker to each juvenile in need of aftercare treatment services.
The aftercare worker shall participate in formulating the
juvenile's ITP and shall attend at least the initial ITP meeting
and the last two ITP meetings for the juvenile prior to release,
one of which shall be within 45-60 days prior to release.
63. Defendants shall hire or contract to provide
sufficient staff to provide meaningful aftercare services. At a
minimum, Defendants agree to provide one aftercare worker for
every 18 juveniles receiving aftercare services.
64. Each aftercare worker shall be adequately trained
and credentialed/certified under the various training programs
offered for such activity through the Department for Social
Services for college and/or graduate study credit at the
universities within Kentucky.
65. Residential treatment services and aftercare
services shall be coordinated, supervised, and provided by the
same agency and shall not be split among various departments or
divisions within CHR.
66. Defendants agree to provide supplemental services
as needed to provide meaningful aftercare services.
E. Time-Out and Isolation
67. Defendants shall adequately protect juveniles
against arbitrary and harmful uses of time-out and isolation. In
order to provide the juveniles with adequate protection against
arbitrary and harmful uses of time-out and isolation, Defendants
shall implement the provisions contained in ¶¶ 67-78.
68. Defendants shall develop specific written criteria
for placing juveniles in either isolation or time-out. Such
criteria will define the nature of the conduct that may result in
the placement and the duration of the placement. These criteria
will be standardized among the residential treatment facilities.
69. Defendants shall immediately cease using isolation
and time-out for punishment or the convenience of staff.
70. Defendants shall place juveniles in isolation only
when such a placement meets specified treatment goals or is
necessary for immediate and short term security. The amount of
time that juveniles spend in isolation shall be the shortest
amount of time necessary to accomplish their treatment goals or
to achieve security.
71. Defendants shall document all placements in
isolation. This report shall contain, at a minimum, the reason
for and duration of the isolation.
72. Defendants shall ensure that no juvenile is placed
in isolation without the approval of the Operations Coordinator
or the superintendent. This approval will be noted on the form
documenting the placement in isolation.
73. For every juvenile placed in isolation, the
Defendants will immediately develop a written action plan for
that juvenile's release. This action plan shall identify the
reasons for the confinement, the criteria for release, and the
services or actions of the staff to achieve the release criteria.
The juvenile shall be released from isolation upon meeting the
74. Defendants shall conduct a formal professional
review of each placement in isolation. This review must be
conducted within an appropriate period following the initial
placement but in no event more than ten hours following the
initial placement. The review shall be repeated at appropriate
intervals while the juvenile remains in isolation but in no event
shall such subsequent reviews be held less often than every four
hours while the juvenile remains in isolation during the day and
every eight hours at night. This review must consider and
evaluate a) whether the initial and continued placement of the
juvenile is necessary to meet treatment goals or immediate and
short term security, b) what amount of time the juvenile should
be isolated to best meet these goals, and c) the action plan
developed in ¶ 73. This review must be conducted by an
appropriately qualified and competent professional, including a
counselor or facility based psychologist. Defendants will
document the occurrence and results of this review.
75. The facility nurse or other medically trained
staff shall examine the juveniles immediately after the juvenile
is placed in isolation, unless it is unsafe to do so, in which
case the nurse shall examine the juvenile when safety permits.
The nurse or other medically trained staff shall document the
date, time, and results of this examination.
76. Defendants will monitor every juvenile in
isolation once every fifteen minutes.
77. In addition to monitoring the juveniles every
fifteen minutes, Defendants shall ensure that every juvenile in
isolation is visited at least once every 24 hours by either a
nurse, social worker or counselor. A visit shall mean, at a
minimum, that the nurse, social worker, or counselor actually
enters the isolation room, unless it is unsafe to do so, and
converses with the juvenile. Defendants shall record the
occurrence of all such visits.
78. Defendants will never place a juvenile who is a
suicide risk into isolation.
F. Staffing, Operational, and Security Procedures
79. Defendants shall ensure that there is adequate
staff at each juvenile treatment facility fully sufficient to
provide reasonable security to all juveniles, ensure their well-being, meet their individual needs, provide adequate treatment,
and permit defendants to fully implement each and every
requirement of this Consent Decree in a timely manner. Staff
shall be adequate in terms of numbers, kind, and qualifications
and training. Such staff shall include, but not be limited to,
Juvenile Treatment Assistants ("JTAs"), Juvenile Treatment
Assistant Principals ("JTAPs"), juvenile counselors, youth
treatment specialists, youth treatment specialist assistants,
teachers and any other staff necessary to fully implement this
Consent Decree. Only staff present and on duty directly
supervising juveniles shall be considered in any evaluation of
the adequacy of staff.
80. In order to maintain sufficient and adequate
staffing levels, utilizing a relief factor, the Defendants shall
also hire and train sufficient extra staff to maintain the
required staffing levels, including periods of staff illness,
training, vacation or other leave of absence. The staffing
levels shall also include enough staff to provide the juveniles
adequate supervision during exercise periods.
81. Defendants shall hire and maintain sufficient
numbers of juvenile counseling positions to adequately implement
juvenile treatment programs, including performing individual and
group counseling as required in each resident's individual
82. All juvenile counselors shall be adequately
trained and credentialed/certified to perform therapeutic
83. Defendants shall hire and maintain adequate
numbers of properly trained (and licensed where applicable)
professional staff to oversee, consult, advise and monitor the
staff of the residential facilities, especially staff involved in
84. The Defendants shall ensure that current and new
treatment center staff members are sufficiently well-trained and
competency-based tested. To this end, the Defendants shall
institute a comprehensive training program, to include, at a
minimum, 80 hours of orientation training to staff (40 hours of
which shall be prior to an employee being independently assigned
to any particular area or duty), and an additional 40 hours of
in-service training each year thereafter. Such program shall
entail, at minimum, training and testing in the following areas:
appropriate training in how to work specifically with adolescents
and adolescent development; crisis intervention, de-escalation of
conflict situations, handling anger, and dispute resolution;
cultural diversity training to better understand different
patterns of development exhibited by juveniles from different
ethnic, racial, and geographical backgrounds; training and
certification with yearly reviews in standard first aid and CPR
(cardiopulmonary resuscitation); training by mental health
professionals in how to recognize and deal with mentally ill
and/or potentially suicidal juveniles; training by a local
medical professional, including training in recognizing the side-effects of medications commonly administered at the treatment
centers; security and search procedures, use of force regulations
and tactics; supervision of juveniles; report writing; juvenile
and staff rules and regulations; rights and responsibilities of
juveniles; all emergency procedures; and training in HIV related
issues. Defendants shall adequately document all training.
85. Program managers shall be required to have the
same level of initial training as front-line staff.
86. Defendants shall require that staff meetings be
held at appropriate intervals among personnel within each
facility and between facility personnel and central office
87. Defendants shall evaluate current personnel
policies, including entry level salaries, and make any necessary
changes or modifications to ensure that competent and qualified
staff are available in adequate numbers at all treatment
G. Medical Care
88. Defendants shall ensure that adequate, regular and
continuous medical care is provided to juveniles at the treatment
centers. In order to provide adequate, regular and continuous
medical care, Defendants shall implement the provisions contained
in ¶¶ 87-102.
89. Defendants must hire or develop a contractual
relationship with a licensed and Board certified physician to
serve as the Statewide Medical Authority for all juvenile
residential treatment facilities. At a minimum, the Statewide
Medical Authority shall approve and supervise a medical quality
assurance program to be used in each residential treatment
facility, and approve and supervise all medical policies,
procedures, and protocols used at the residential treatment
90. For each facility, Defendants must either hire or
develop a contractual relationship with the following medical
personnel: (1) a physician to consult with facility medical staff
and provide sick call services as needed, provide 24 hours/day,
seven days/week on-call medical coverage, arrange for admission,
when necessary, to a local hospital, and meet quarterly with the
psychologists, psychiatrists, and nursing staff; (2) one full-time registered nurse (RN) and one licensed practical nurse (LPN)
on back-up; and (3) major sub-specialty medical care providers to
evaluate and provide care for juveniles referred to them by the
treatment centers' physician.
91. The RNs and LPNs shall be responsible for all
aspects of medication administration including handling,
measuring, dispensing, and storing all medications, except that
facility staff may assist in the limited role of distributing
medications. Such facility staff shall not repackage, measure or
dispense medications and shall be fully and adequately trained
and supervised by a physician, RN, or LPN. Such training shall
include, but shall not be limited to, the nature and side-effects
of the distributed medications. The RNs and LPNs shall also be
involved in the medical quality assurance system, and shall
review Medication Administration Record ("MAR") sheets on a
92. In consultation with the Statewide Medical
Authority and in accordance with accepted medical standards,
Defendants shall revise and update the intake medical/mental
health screening form used to evaluate all juveniles upon their
admission to the treatment centers.
93. Defendants must provide inservice training to all
appropriate staff in how to complete the screening form.
94. Defendants shall use medically trained treatment
center personnel or a medical professional to conduct medical
95. All medical screening forms with positive
responses must be reviewed by a nurse or physician and must
become part of a juvenile's medical records or charts.
96. In consultation with the Statewide Medical
Authority, Defendants shall develop and implement adequate sick
call procedures that include (1) review of juvenile requests by
qualified personnel on a daily basis to determine urgency of need
to be seen, (2) sick call clinic to be held five times per week
Monday through Friday; and (3) recording the results of all sick
call encounters in juvenile records.
97. Defendants shall ensure that any juvenile
transferred among residential treatment facilities or to or from
any other facility is delivered safely and with all immunization
certificates, medical information including screening forms and
records, psychological evaluations (if any), birth verification,
commitment order, social history and social needs assessment, a
copy of his social security card, and a copy of his education
records. Defendants' medical personnel shall contact the medical
personnel at the discharging facility to ensure that all medical
documentation has been received.
98. Facility staff shall communicate to succeeding
shifts medical problems with juveniles through a written shift
report and by oral communication between shift staff that shall
also be documented in the shift report.
99. Defendants must develop and implement a policy and
procedure to specify minimum follow-up frequency and minimum
evaluation for juveniles identified with acute and chronic
100. In all cases of juveniles confined at the
treatment centers for seven days or more, Defendants shall
administer a PPD test for Tuberculosis (TB) with the results of
the test forwarded immediately to the facility physician. If the
test result is positive, the juvenile shall be immediately
scheduled for a chest x-ray, with appropriate medical care and
attention, including isolation, to be provided thereafter as
101. Defendants shall implement policies and
procedures regarding HIV and AIDS in conjunction with the local
public health department and/or a physician.
102. All over-the-counter drugs shall be in unit
103. No juvenile shall be disciplined for or otherwise
discouraged from accessing the health care delivery system.
H. Mental Health Care
104. Defendants shall ensure that adequate, regular
and continuous mental health care is provided to juveniles at the
treatment centers. In order to ensure that adequate, regular and
continuous mental health care is provided, Defendants shall
implement the following substantive provisions contained in ¶¶ 104-118.
105. Defendants must either hire or develop a
contractual relationship with the following mental health
personnel: (1) a licensed psychiatrist (or a psychiatric resident
in training under supervision of a licensed psychiatrist) present
at the facility for four hours per week and available on call, as
needed, for providing such services as crises intervention,
diagnosing juveniles, medication prescriptions and renewals, and
other consultation, as appropriate. The licensed psychiatrist
shall be Board certified and where available shall be Board
certified in child psychiatry; (2) one facility based clinical
psychologist with a minimum of a masters degree in psychology
present at the facility for every 45 juveniles. Each facility
shall have at least one such facility based psychologist. In
rural areas, if after their best efforts, Defendants are unable
to hire or contract with a Ph.D or masters level psychologist,
Defendants may use a QMHP. The facility based psychologist (or
QMHP in rural areas) shall function as the treatment coordinator
for the juveniles of each facility. If the facility based
psychologist has only a masters degree in psychology or is a
QMHP, he/she shall be supervised by a licensed clinical Ph.D.
psychologist; (3) sufficient Ph.D. clinical psychologists to
comply with the terms of this Decree, including supervising
facility based psychologists and QMHPs, providing treatment to
juveniles when needed, conducting and reviewing mental health
evaluations of juveniles, reviewing and approving policies and
procedures concerning the mental health care of juveniles and
otherwise overseeing the provision of mental health services to
juveniles; and (4) major sub-specialty mental health care
providers to evaluate and provide care for juveniles referred to
them by the treatment centers' psychologists.
106. Defendants shall write and implement policies and
procedures for treatment referrals from the QMHP or masters level
psychologist to a Ph.D. psychologist or psychiatrist as
appropriate for juveniles' treatment needs. At a minimum, these
policies shall provide for immediate and automatic referral for
appropriate treatment to a Ph.D. psychologist or psychiatrist
whenever: a) a juvenile's mental health poses a risk of physical
harm to himself or others (e.g., any suicidal ideation); b) any
juvenile exhibiting any mental health problems does not have a
current mental health diagnosis from a Ph.D. psychologist or
psychiatrist; or c) any juvenile requires a change of medication
prescribed as a result of any mental health condition (including
initiating and terminating medications).
107. Defendants shall ensure that the facility
psychologist(s) oversees the provision of mental health services
to juveniles and provides clinical oversight to the juveniles'
108. The Defendants shall screen all juveniles for
suicide risk, special needs, and acute mental distress
immediately upon their admission to the treatment centers.
Defendants shall revise its medical screening form to include
sufficient inquiry into such mental health conditions. The
mental health and suicide risk portion of the medical screening
questionnaire shall be administered by mental health trained
staff and reviewed by the facility based psychologist. The
reviewing facility based psychologist must sign the screening
form to indicate the form has been reviewed and assessed. All
such screening forms shall be forwarded to the medical unit.
109. Defendants shall provide mental health
evaluations to juveniles who have not had a mental health
evaluation within the preceding year if the juvenile is not on
psychotropic medication. Defendants will perform this evaluation
within 14 days of admission if the juvenile has not had a mental
health evaluation in the preceding year or arrives at the
facility without such an evaluation. Otherwise, Defendants shall
perform this evaluation within 14 days after the expiration of
one year after the juvenile's last mental health evaluation.
Defendants will provide such mental health evaluations more
frequently if such evaluations are necessary to provide adequate
110. Defendants shall provide mental health
evaluations to juveniles taking psychotropic medications and who
have not had a mental health evaluation within the preceding six
months. Defendants will perform this evaluation within 14 days
of admission if the juvenile has not had a mental health
evaluation in the preceding six months or arrives at the facility
without such an evaluation. Otherwise, Defendants will perform
this evaluation within 14 days after the expiration of six months
after the juvenile's last mental health evaluation. Defendants
will provide such mental health evaluations more frequently if
such evaluations are necessary to provide adequate treatment.
111. A mental health evaluation must be performed by
either a psychiatrist or Ph.D. psychologist, and must contain at
least a complete Mental Status Evaluation (MSE) and additional
psychological testing as appropriate for the juvenile's special
112. Defendants shall ensure that the facility based
psychologist reviews medical screening forms and the mental
health evaluation of each juvenile.
113. A psychiatrist or Ph.D. psychologist shall
develop and Defendants shall implement an adequate mental health
treatment plan for all juveniles on psychotropic medication and
for all juveniles identified as in need of mental health
114. Defendants shall ensure that a mental health care
provider is available on-call 24 hours a day, seven days per
week, for crisis intervention services. Defendants shall arrange
for psychiatric beds when needed either at the treatment centers,
or at a local hospital.
115. If the appropriate mental health care
professional recommends that any juvenile needs further mental
health treatment or review, the Defendants shall promptly arrange
for such treatment and shall promptly transport the juvenile to
obtain such treatment.
116. The Defendants shall develop and implement
written policies and procedures on suicide prevention and the
treatment of special needs juveniles.
117. Defendants shall ensure that all direct care
staff receive adequate training by a licensed mental health
professional in the proper response to a suicide or suicide
attempt, in identifying and screening juveniles, and in
recognizing high-risk groups and periods for suicide and suicide
118. Immediately upon signing the Consent Decree,
Defendants shall renovate all treatment facility isolation rooms
to ensure that they contain no exposed conduits, sharp edges, or
other hazards that could be utilized in a suicide attempt.
119. Defendants shall adequately assess, classify and
place juveniles among Kentucky facilities. In order to
adequately assess, classify and place juveniles among Kentucky
facilities, Defendants shall implement the following substantive
provisions contained in ¶¶ 119-124.
120. Defendants shall classify juveniles by using a
risk evaluation model that contains, at a minimum, reference to
the offense the juvenile committed and an individual assessment
of each juvenile's social, medical, and psychological records.
121. Juvenile classification and reclassification
shall be performed by a team of trained personnel.
122. Defendants shall ensure that the classification
team receives all information necessary to make an adequate
juvenile classification. This information shall include the
court order and any educational records, social or behavioral
assessments, psychological evaluations, or physical evaluations.
123. Defendants shall place juveniles among the
treatment facilities in a manner such that each juvenile is
placed in the least restrictive environment appropriate to his
classification. No juvenile shall be placed in a facility that
is incapable of treating his or her special needs.
124. No juvenile will be housed in a treatment
facility that does not match the juvenile's general
classification. No juvenile shall be transferred to a treatment
facility of a different classification level unless that juvenile
has been reclassified.
J. Fire Safety
125. In order that juvenile treatment centers are made
fire safe, the Defendants shall institute the following upgrades
a. remove or otherwise secure all exposed
extension cords and electrical conduits and comply with all state
and local electrical codes;
b. remove or cover all dangerous exposed
lightbulbs in the facilities and replace fixtures with security
126. Treatment center staff shall continue to be
trained in fire prevention and emergency procedures, including
evacuation plans. Such training shall be documented.
K. Bedspace and Overcrowding
127. No juvenile shall be housed in any area other
than properly designated living quarters, and no juveniles shall
be made to sleep on the floor, or a closet, or in any place other
than a bed raised at least twelve inches off the floor.
128. The population shall not exceed the number of
available beds in properly designated living quarters not under
construction, renovation, or dedicated to alternative uses.
Defendants shall continue to maintain records of daily juvenile
population and the number of juveniles in each room.
L. Maintenance and Sanitation
129. Defendants shall remove old stains and
scale/shower film and eliminate bacteria in the shower and living
quarter areas. This cleaning shall be in addition to ongoing
daily maintenance and sanitation.
130. Defendants shall develop and implement written
policies and procedures to ensure the daily cleaning of all
juvenile living quarters. It shall be the responsibility of
treatment center staff to inspect all areas regularly to maintain
V. TREATMENT CENTER CONSTRUCTION AND/OR RENOVATION
131. If the Defendants decide to construct new
treatment facilities or to substantially renovate or otherwise
replace any existing treatment facility, the Defendants agree to
construct any new treatment centers or renovate\replace the
existing facility in compliance with: (1) the American
Correctional Association's ("ACA") standards in effect at the
time of construction; (2) the Americans with Disabilities Act of
1990, 42 U.S.C. §§ 12101 et seq., and the regulations thereunder;
and (3) all Kentucky fire codes and regulations. In addition,
once construction or renovation\replacement is completed, the
Defendants agree to seek, gain and maintain ACA accreditation.
VI. CONSTRUCTION, IMPLEMENTATION, AND TIMING OF COMPLIANCE
132. Except where otherwise specifically indicated,
the Defendants shall implement all provisions of this Decree
within 180 days after signing this Decree.
133. This Consent Decree shall apply to all juvenile
treatment centers operated by or on behalf of the Commonwealth of
134. Within 30 days after the entry of this Decree,
Defendants agree to appoint a Monitor who shall on a quarterly
basis monitor Defendants' compliance with each provision of this
Consent Decree. The Monitor shall be acceptable to both parties.
If the parties are unable to agree on a Monitor, both parties
shall submit names to the Court and the Court shall select the
Monitor. Kentucky shall bear the costs of the Monitor and
required monitoring activities.
135. Every ninety (90) days following the signing of
this Decree and until this Decree is terminated, Defendants shall
file with the Court and the Monitor, and with a copy to the
United States, a status report stating whether the Defendants are
complying with the terms of this Decree. As part of the status
report, Defendants shall include a report listing the daily
juvenile population of the treatment centers and the number of
juveniles in each sleeping unit.
136. The status reports shall describe the actions
that the Defendants have taken up to and including the current
reporting period to implement this Consent Decree and shall
specifically refer to the provisions of this Consent Decree upon
which they report. In addition, every ninety (90) days
Defendants shall provide a summary of the frequency and duration
of the use of isolation per juvenile at each facility.
137. The Defendants shall maintain sufficient records
to document their compliance with all terms of this Decree.
Defendants shall also maintain any and all records required by or
developed under this Consent Decree.
138. During all times while the Court maintains
jurisdiction over this action, the Monitor and the United States
shall have unrestricted access to and, upon request, receive
copies of any document relating to the implementation of this
Decree. The Monitor and the United States shall have
unrestricted access to all staff and facilities as necessary to
address issues affected by this Decree.
139. The United States and the Monitor shall treat as
confidential records and documents provided by the Commonwealth
of Kentucky Cabinet for Human Resources. This agreement does not
bar the United States or the Monitor from providing such records
and documents to its attorneys, employees and expert consultants
for the purposes of any investigation under 42 U.S.C. § 1997 et
seq., or the provisions of Pub. L. No. 103-322, 108 Stat. 2071
(codified at 42 U.S.C. § 14141). This agreement does not bar the
United States or the Monitor from providing such information to
any court that may have jurisdiction over any subsequent action
taken pursuant to 42 U.S.C. § 1997 et seq., or the provisions of
Pub. L. No. 103-322, 108 Stat. 2071 (codified at 42 U.S.C. §
140. The Defendants shall immediately explain the
terms of this Decree to all persons connected with the treatment
centers, including treatment centers staff in order to ensure
that they understand the requirements of this Decree and the
necessity for its strict compliance. All treatment centers staff
members and other individuals providing services required by this
Decree shall sign a statement indicating that they have read and
understand this Decree and acknowledge receiving an individual
copy of the Decree. Such statement shall be retained by the
Defendants. The Defendants shall require strict compliance with
this Decree by their respective employees, agencies, assigns, or
141. The Court shall retain jurisdiction of this
action for all purposes during the lifetime of this Consent
Decree and until such time as the Commonwealth has fully and
faithfully implemented all requirements of the Consent Decree and
such full compliance has been maintained for one year. At such
time as the Commonwealth has determined that it is in full and
faithful compliance with the Consent Decree and that full
compliance has been maintained for no less than one year, the
Commonwealth shall advise the United States in writing.
Thereafter, the parties shall promptly confer as to the status of
compliance. If, after a reasonable period of consultation and
the completion of any evaluation the United States may wish to
undertake, including tours of the juvenile treatment centers, the
parties cannot resolve any compliance issues, the Commonwealth
may file a motion to dismiss. If the Commonwealth moves for
dismissal of this Consent Decree, the United States will have an
adequate time after the receipt of Defendants' motion to object
to the motion. If the United States does not object, the Court
may grant Defendants' motion. If the United States does make
such an objection, the Court shall hold a hearing on the motion
and the burden shall be on the Commonwealth to demonstrate that
it has fully and faithfully implemented all provisions of this
Consent Decree and maintained such compliance for at least one
Agreed to by:
COUNSEL FOR UNITED STATES:
JANET RENO, Attorney General of the United States
DEVAL L. PATRICK, Assistant Attorney General, Civil Rights Division
ARTHUR E. PEABODY, JR., Chief, Special Litigation Section
ROBINSUE FROHBOESE, Deputy Chief, Special Litigation Section
United States Department of Justice
MICHAEL TROOP, United States Attorney, Western District of Kentucky
WILLIAM G. MADDOX
ROBERT J. MOOSSY, JR.
U.S. Department of Justice
Civil Rights Division
Special Litigation Section
Post Office Box 66400
Washington, D.C. 20035
COUNSEL FOR DEFENDANTS:
BRERETON C. JONES, Governor, Commonwealth of Kentucky
MASTEN CHILDERS II, Secretary, Kentucky Cabinet for Human Resources
JOHN E. KUHN, JR., Deputy Counsel, Office of the Counsel
Also for PEGGY WALLACE, Commissioner of the Department for Social Services;
BETTY SHIPP, Director of Youth Services;
ELIZABETH WACHTEL, Commissioner for Mental Health and Mental Retardation
Kentucky Cabinet for Human Resources
Frankfort, Kentucky 40621-0001
It is hereby Ordered, this ______ day of _________________, 1995.
UNITED STATES DISTRICT JUDGE